When to consider a geriatrician

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The year was 1971, and a teenager named Martin Gorbien was working part-time for two physical therapists treating older people. Inclined to fondness for older people as a result of his interactions with his own older family members, Gorbien watched how the physical therapists treated their patients, and came away very much impressed. "They said, 'This is the future,'" he recalls.

The future, they noted, would see older people surviving cancer and heart disease, but suffering multiple chronic diseases. "I loved what I saw the physical therapists doing . . . not dismissing people because of their age," he says.

That teenager grew up to be Dr. Martin J. Gorbien, director of the division of geriatric medicine and palliative care at Chicago's Rush University. Gorbien is among the all-too-small group of doctors known as geriatricians, a term referring to internists or family medicine doctors focused on helping maintain and promote health in older adults with complex medical needs.

While patients go to cardiologists with chest pains, or to rheumatologists with shoulder soreness, the reasons patients visit a geriatrician are often not so specifically defined, Gorbien reports. "It could be memory loss, a question about medication, about a living situation, it could be about a fall," he says.

It is typically assumed that geriatricians treat people 65 and older, says Dr. Rani Rao, internist and geriatrician at Loyola University Medical Center in Maywood. "But if you have complex health care problems at ages younger than 65, you should consider consulting a geriatrician," she says.

"People with dementia, who are frail, who have balance problems while walking, who lose weight and have difficulty functioning, people who are declining in terms of their emotional and physical health, these are the people who would particularly benefit from the care of a geriatrician."

Both patients and families of older adults seek out geriatricians, says Dr. William Dale, associate professor and chief of the section of geriatrics and palliative medicine at the University of Chicago. In addition, other providers, often internists, refer their own older patients, if they are becoming more difficult to care for, Dale says. "In general, we spend more time with patients in clinic than other doctors," he adds. "We also care for their psychosocial needs more than do other physicians, and families appreciate that as well."

To provide an example, a family might bring an older relative to a geriatrician with issues of balance and falling, Rao says. The geriatrician would begin by doing a comprehensive history, looking into circumstances of the fall, home environment, medication list, potential drug interactions and side effects.

The geriatrician would undertake a physical examination of the patient, observe his or her gait, provide advice on fall prevention, evaluate the benefits and risks of the medications and devise a plan of care involving participation from other providers, such as physical therapists and home health-care nurses.

"Often there is an overlap of other medical conditions that are making the person frail, and causing falls," Rao adds. "All or several issues such as dementia, osteoarthritis and neuropathy could co-exist with the fall."

Traits of the best geriatricians

According to Gorbien, the top three attributes of the best geriatricians may be patience, availability and engagement.

Adds Dale: "The ability to coordinate care is very important. You have to be able to negotiate between multiple other providers, as well as affiliated health care providers, particularly physical therapists, social workers and nurses."

Dale agrees with Gorbien on the importance of patience. "You want someone who will take the time to cover all the complexities of care," he says.

"Everyone in the field is so nice, friendly and interactive. Those characteristics stand out in geriatrics. Those bedside manner traits we appreciate as patients? Geriatricians have them in abundance."

Given the aging population of Baby Boomers and the fact folks tend to live longer these days, there will always be need for geriatricians in the United States, Dale says. "So if you want to find work in a field with high job satisfaction, and are considering medicine, this is the field to enter." ■